NR547 Week 8 Exam V2 | NR547
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 8 Exam) | Chamberlain University
1. When conducting a differential diagnosis for a patient presenting with symptoms of
depression, which laboratory test is most essential to rule out a common medical mimic?
A. Thyroid Stimulating Hormone (TSH)
B. Complete Blood Count (CBC)
C. Serum Creatinine
D. Blood Alcohol Content (BAC)
Answer: A
Rationale: Hypothyroidism is a well-documented medical condition that can present with
symptoms nearly identical to Major Depressive Disorder, including lethargy and low mood.
Assessing the TSH level allows the PMHNP to ensure that the psychiatric symptoms are not
primarily caused by an endocrine imbalance. Ruling out organic causes is a foundational
step in the psychiatric differential diagnosis process.
2. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder (GAD)?
A. 2 weeks
,B. 1 month
C. 6 months
D. 1 year
Answer: C
Rationale: Generalized Anxiety Disorder requires that excessive anxiety and worry occur
more days than not for at least 6 months about a number of events or activities. This
duration helps distinguish chronic anxiety from transient stress or adjustment disorders.
The clinician must also ensure the anxiety is difficult to control and associated with
physical symptoms such as muscle tension or sleep disturbance.
3. A 9-year-old child presents with persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis should the PMHNP
consider first?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder (ODD)
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Rationale: DMDD was specifically added to the DSM-5 to address the over-diagnosis of
Bipolar Disorder in children who present with chronic irritability rather than episodic
,mania. The criteria require the outbursts to occur three or more times per week in at least
two settings. This diagnosis is only applicable to children between the ages of 6 and 18.
4. Which screening tool is most appropriate for a clinician to use when evaluating a patient
for Bipolar Disorder?
A. PHQ-9
B. GAD-7
C. CAGE-AID
D. Mood Disorder Questionnaire (MDQ)
Answer: D
Rationale: The Mood Disorder Questionnaire (MDQ) is a validated screening instrument
designed to identify symptoms of mania and hypomania associated with Bipolar Spectrum
Disorders. While the PHQ-9 assesses depression, it does not screen for the history of
elevated mood required for a bipolar diagnosis. Positive screens on the MDQ should be
followed by a comprehensive clinical interview to confirm the diagnosis.
5. A patient reports experiencing a sudden onset of intense fear, palpitations, and shortness
of breath that peaks within minutes. These episodes occur unexpectedly. What is the most
likely diagnosis?
A. Social Anxiety Disorder
B. Panic Disorder
C. Specific Phobia
, D. Post-Traumatic Stress Disorder
Answer: B
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks that
involve intense physical and cognitive symptoms. For a formal diagnosis, at least one attack
must be followed by one month or more of persistent concern about additional attacks or
maladaptive changes in behavior. The clinician must rule out other causes such as caffeine
intoxication or hyperthyroidism.
6. In differentiating between Dementia and Depression in an elderly patient, which feature is
more characteristic of Depression?
A. A ‘don’t know’ response to questions
B. Effort to perform tasks despite failure
C. Slow onset of memory loss
D. Sun-downing behavior
Answer: A
Rationale: Depression in the elderly, sometimes referred to as ‘pseudodementia,’ often
presents with patients highlighting their cognitive failures and frequently giving ‘I don’t
know’ answers. Conversely, patients with true dementia often try to minimize their deficits
or cover them with confabulation. The onset of depression is typically more acute
compared to the insidious progression of neurocognitive disorders like Alzheimer’s.
Differential Diagnosis in Psychiatric-
Mental Health across the Lifespan
Practicum | Q&A with Rationale (NR547
Week 8 Exam) | Chamberlain University
1. When conducting a differential diagnosis for a patient presenting with symptoms of
depression, which laboratory test is most essential to rule out a common medical mimic?
A. Thyroid Stimulating Hormone (TSH)
B. Complete Blood Count (CBC)
C. Serum Creatinine
D. Blood Alcohol Content (BAC)
Answer: A
Rationale: Hypothyroidism is a well-documented medical condition that can present with
symptoms nearly identical to Major Depressive Disorder, including lethargy and low mood.
Assessing the TSH level allows the PMHNP to ensure that the psychiatric symptoms are not
primarily caused by an endocrine imbalance. Ruling out organic causes is a foundational
step in the psychiatric differential diagnosis process.
2. According to the DSM-5-TR, what is the minimum duration of symptoms required for a
diagnosis of Generalized Anxiety Disorder (GAD)?
A. 2 weeks
,B. 1 month
C. 6 months
D. 1 year
Answer: C
Rationale: Generalized Anxiety Disorder requires that excessive anxiety and worry occur
more days than not for at least 6 months about a number of events or activities. This
duration helps distinguish chronic anxiety from transient stress or adjustment disorders.
The clinician must also ensure the anxiety is difficult to control and associated with
physical symptoms such as muscle tension or sleep disturbance.
3. A 9-year-old child presents with persistent irritability and frequent, severe temper
outbursts that are out of proportion to the situation. Which diagnosis should the PMHNP
consider first?
A. Bipolar I Disorder
B. Oppositional Defiant Disorder (ODD)
C. Disruptive Mood Dysregulation Disorder (DMDD)
D. Conduct Disorder
Answer: C
Rationale: DMDD was specifically added to the DSM-5 to address the over-diagnosis of
Bipolar Disorder in children who present with chronic irritability rather than episodic
,mania. The criteria require the outbursts to occur three or more times per week in at least
two settings. This diagnosis is only applicable to children between the ages of 6 and 18.
4. Which screening tool is most appropriate for a clinician to use when evaluating a patient
for Bipolar Disorder?
A. PHQ-9
B. GAD-7
C. CAGE-AID
D. Mood Disorder Questionnaire (MDQ)
Answer: D
Rationale: The Mood Disorder Questionnaire (MDQ) is a validated screening instrument
designed to identify symptoms of mania and hypomania associated with Bipolar Spectrum
Disorders. While the PHQ-9 assesses depression, it does not screen for the history of
elevated mood required for a bipolar diagnosis. Positive screens on the MDQ should be
followed by a comprehensive clinical interview to confirm the diagnosis.
5. A patient reports experiencing a sudden onset of intense fear, palpitations, and shortness
of breath that peaks within minutes. These episodes occur unexpectedly. What is the most
likely diagnosis?
A. Social Anxiety Disorder
B. Panic Disorder
C. Specific Phobia
, D. Post-Traumatic Stress Disorder
Answer: B
Rationale: Panic Disorder is characterized by recurrent, unexpected panic attacks that
involve intense physical and cognitive symptoms. For a formal diagnosis, at least one attack
must be followed by one month or more of persistent concern about additional attacks or
maladaptive changes in behavior. The clinician must rule out other causes such as caffeine
intoxication or hyperthyroidism.
6. In differentiating between Dementia and Depression in an elderly patient, which feature is
more characteristic of Depression?
A. A ‘don’t know’ response to questions
B. Effort to perform tasks despite failure
C. Slow onset of memory loss
D. Sun-downing behavior
Answer: A
Rationale: Depression in the elderly, sometimes referred to as ‘pseudodementia,’ often
presents with patients highlighting their cognitive failures and frequently giving ‘I don’t
know’ answers. Conversely, patients with true dementia often try to minimize their deficits
or cover them with confabulation. The onset of depression is typically more acute
compared to the insidious progression of neurocognitive disorders like Alzheimer’s.
